Pulmonary Function Test in Rheumatoid Arthritis Patients
,
Abstract
Lung disease is a common and important contributor to morbidity and mortality in rheumatoid arthritis (RA) patients. Studies have shown that diagnostic methods can reveal hidden pulmonary diseases even in RA patients with no respiratory symptoms. In this study, we assessed pulmonary function tests (PFTs) and chest radiographs (CXRs) in RA patients with more than three years of illness to find a suitable instrument for prospecting RA-induced lung diseases. We conducted a prospective cross-sectional study on 57 RA patients. Demographic, clinical, and CXR data were recorded. Residual volume (RV), total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC ratio was assessed. According to the FEV1/FVC ratio, patients were divided into three groups: FEV1/FVC below 70% (obstructive pattern) in 5% and between 70% and 85% (normal) in 50%, and above 85% (restrictive lung disease) in 45% of RA patients. Normal X-ray was the most common finding in CXR, and only cystic changes and reticular changes were found in 5% of patients. Analysis showed a significant relationship between abnormal chest images and the duration of disease (P=0.025), but PFT data did not result in any significance. Respiratory symptoms or clinical examinations are positive findings in the evaluation of asymptomatic patients, and using PFT is more rational than CXR. Our data show that there is no correlation between the disease duration and PFT data; hence, asymptomatic patients with a variety of risk factors should undergo further investigation.
1. Arora S, Rafiq A, Jolly M. Management of rheumatoid arthritis: Review of current guidelines. J Arthrosc Joint Surg 2016;3:45-50.
2. Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res 2018;6:15.
3. Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int 2021;41:863-77.
4. Jamshidi AR, Banihashemi AT, Roknsharifi S, Akhlaghi, M, Salimzadeh A, Davatchi F. Estimating the prevalence and disease characteristics of rheumatoid arthritis in Tehran: A WHO-ILAR COPCORD Study (from Iran COPCORD study, Urban Study stage 1). Med J Islam Repub Iran 2014;28:93.
5. Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev 2015;24:1-16.
6. Marigliano B, Soriano A, Margiotta D, Vadacca M, Afeltra A. Lung involvement in connective tissue diseases: a comprehensive review and a focus on rheumatoid arthritis. Autoimmunity Rev 2013;12:1076-84.
7. O'Dwyer DN, Armstrong ME, Cooke G, Dodd JD, Veale DJ, Donnelly SC. Rheumatoid Arthritis (RA) associated interstitial lung disease (ILD). Eur J Intern Med 2013;24:597-603.
8. Saadati N, Naghibzadeh B, Khalilipour A, Miri M. Association Between Rheumatoid Arthritis and Pulmonary Hypertension: A Clinical Investigation. Acta Med Iran 2021;58:567-71.
9. Chansakul T, Dellaripa PF, Doyle TJ, Madan R. Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol 2015;84:1981-91.
10. Olson AL, Swigris JJ, Sprunger DB, Fischer A, Fernandez-Perez ER, Solomon J, et al. Rheumatoid arthritis-interstitial lung disease-associated mortality. Am J Respir Crit Care Med 2011;183:372-8.
11. Doyle TJ, Lee JS, Dellaripa PF, Lederer JA, Matteson EL, Fischer A, et al. A roadmap to promote clinical and translational research in rheumatoid arthritis-associated interstitial lung disease. Chest 2014;145:454-63.
12. Metafratzi ZM, Georgiadis AN, Ioannidou CV, Alamanos Y, Vassiliou MP, Zikou AK, et al. Pulmonary involvement in patients with early rheumatoid arthritis. Scand J Rheumatol 2007;36:338-44.
13. Kawassaki AM, Pereira DA, Kay FU, Laurindo IM, Carvalho CR, Kairalla RA. Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry. J Bras Pneumol 2015;41:331-42.
14. Habib HM, Eisa AA, Arafat WR, Marie MA. Pulmonary involvement in early rheumatoid arthritis patients. Clin Rheumatol 2011;30:217-21.
15. Robles-Perez A, Luburich P, Rodriguez-Sanchon B, Dorca J, Nolla JM, Molina-Molina M, et al. Preclinical lung disease in early rheumatoid arthritis. Chron Respir Dis 2016;13:75-81.
16. Zayeni H, Haji-Abbasi A, Foumani SA, Tohidi M, Masooleh IS, Parsa BG, et al. Pulmonary involvement in rheumatoid arthritis: A cross-sectional study in Iran. Lung India 2016;33:49-52.
17. Rojas-Serrano J, Herrera-Bringas D, Perez-Roman DI, Perez-Dorame R, Mateos-Toledo H, Mejia M. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis. Clin Rheumatol 2017;36:1493-500.
18. Fragoulis GE, Nikiphorou E, Larsen J, Korsten P, Conway R. Methotrexate-Associated Pneumonitis and Rheumatoid Arthritis-Interstitial Lung Disease: Current Concepts for the Diagnosis and Treatment. Front Med (Lausanne) 2019;6:238.
19. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81.
20. Cavagna L, Monti S, Grosso V, Boffini N, Scorletti E, Crepaldi G, et al. The multifaceted aspects of interstitial lung disease in rheumatoid arthritis. BioMed Res Int 2013;2013:759760.
21. Ha YJ, Lee YJ, Kang EH. Lung Involvements in Rheumatic Diseases: Update on the Epidemiology, Pathogenesis, Clinical Features, and Treatment. Biomed Res Int 2018;2018:6930297.
22. Iqbal K, Kelly C. Treatment of rheumatoid arthritis-associated interstitial lung disease: a perspective review. Ther Adv Musculoskelet Dis 2015;7:247-67.
23. Yunt ZX, Chung JH, Hobbs S, Fernandez-Perez ER, Olson AL, Huie TJ, et al. High resolution computed tomography pattern of usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease: Relationship to survival. Respir Med 2017;126:100-4.
24. Solomon JJ, Chung JH, Cosgrove GP, Demoruelle MK, Fernandez-Perez ER, Fischer A, et al. Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J 2016;47:588-96.
25. Yunt ZX, Solomon JJ. Lung disease in rheumatoid arthritis. Rheum Dis Clin North Am 2015;41:225-36.
26. Ellman P, Ball RE .Rheumatoid disease" with joint and pulmonary manifestations. Br Med J 1948;2:816-20.
27. Cortet B, Flipo RM, Remy-Jardin M, Coquerelle P, Duquesnoy B, Remy J, et al. Use of high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 1995;54:815-9
28. Morrison SC, Mody GM, Benatar SR, Meyers OL. The lungs in rheumatoid arthritis--a clinical, radiographic and pulmonary function study. S Afr Med J 1996;86:829-33.
29. .Bhattacharya P, Ghosh S, Sengupta S, Dasgupta A, Ghosh K, Ghosh B. Clinicoradiological profile of interstitial lung disease in rheumatoid arthritis. Asian J Med Sci 2019;10:66-71.
30. Kalyani Praba P, Thamarai Selvi K, Vijay Anand B, Saravanan A. Evaluation of lung function tests in rheumatoid arthritis patients. Natl J Physiol Pharm Pharmacol 2017;7:693-6.
31. Hassan WU, Keaney NP, Holland CD, Kelly CA. Bronchial reactivity and airflow obstruction in rheumatoid arthritis. Ann Rheum Dis 1994;53:511-4.
32. Halimi L, Haghdoost AA, Alizadeh SM. Prevalence of cigarette smoking among Iranian women: a systematic review and meta-analysis. Med J Islam Repub Iran 2013;27:132-40.
33. Cereser L, Zuiani C, Graziani G, Girometti R, Como G, Zaja F, et al. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. Radiol Med 2010;115:205-14.
34. Gavelli G, Giampalma E. Sensitivity and specificity of chest X-ray screening for lung cancer: review article. Cancer 2000;89:2453-6.
35. Zrour SH, Touzi M, Bejia I, Golli M, Rouatbi N, Sakly N, et al. Correlations between high-resolution computed tomography of the chest and clinical function in patients with rheumatoid arthritis: prospective study in 75 patients. Joint Bone Spine 2005;72:41-7.
36. Lamblin C, Bergoin C, Saelens T, Wallaert B. Interstitial lung diseases in collagen vascular diseases. Eur Respir J Suppl 2001;32:69s-80.
37. Gabbay E, Tarala R, Will R, Carroll G, Adler B, Cameron D, et al. Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 1997;156:528-35.
38. Salliot C, van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 2009;68:1100-4.
39. Kinder AJ, Hassel AB, Brand J, Brownfield A, Grove M, Shadforth MF. The treatment of inflammatory arthritis with methotrexate in clinical practice: treatment duration and incidence of adverse drug reactions. Rheumatology (Oxford) 2005;44:61-6.
40. Conway R, Low C, Coughlan RJ, O'Donnell M, Carey JJ. Methotrexate and interstitial lung disease in rheumatoid arthritis-a systematic literature review and meta-analysis. Arthritis Rheumatol 2012;64(s918).
2. Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res 2018;6:15.
3. Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int 2021;41:863-77.
4. Jamshidi AR, Banihashemi AT, Roknsharifi S, Akhlaghi, M, Salimzadeh A, Davatchi F. Estimating the prevalence and disease characteristics of rheumatoid arthritis in Tehran: A WHO-ILAR COPCORD Study (from Iran COPCORD study, Urban Study stage 1). Med J Islam Repub Iran 2014;28:93.
5. Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev 2015;24:1-16.
6. Marigliano B, Soriano A, Margiotta D, Vadacca M, Afeltra A. Lung involvement in connective tissue diseases: a comprehensive review and a focus on rheumatoid arthritis. Autoimmunity Rev 2013;12:1076-84.
7. O'Dwyer DN, Armstrong ME, Cooke G, Dodd JD, Veale DJ, Donnelly SC. Rheumatoid Arthritis (RA) associated interstitial lung disease (ILD). Eur J Intern Med 2013;24:597-603.
8. Saadati N, Naghibzadeh B, Khalilipour A, Miri M. Association Between Rheumatoid Arthritis and Pulmonary Hypertension: A Clinical Investigation. Acta Med Iran 2021;58:567-71.
9. Chansakul T, Dellaripa PF, Doyle TJ, Madan R. Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol 2015;84:1981-91.
10. Olson AL, Swigris JJ, Sprunger DB, Fischer A, Fernandez-Perez ER, Solomon J, et al. Rheumatoid arthritis-interstitial lung disease-associated mortality. Am J Respir Crit Care Med 2011;183:372-8.
11. Doyle TJ, Lee JS, Dellaripa PF, Lederer JA, Matteson EL, Fischer A, et al. A roadmap to promote clinical and translational research in rheumatoid arthritis-associated interstitial lung disease. Chest 2014;145:454-63.
12. Metafratzi ZM, Georgiadis AN, Ioannidou CV, Alamanos Y, Vassiliou MP, Zikou AK, et al. Pulmonary involvement in patients with early rheumatoid arthritis. Scand J Rheumatol 2007;36:338-44.
13. Kawassaki AM, Pereira DA, Kay FU, Laurindo IM, Carvalho CR, Kairalla RA. Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry. J Bras Pneumol 2015;41:331-42.
14. Habib HM, Eisa AA, Arafat WR, Marie MA. Pulmonary involvement in early rheumatoid arthritis patients. Clin Rheumatol 2011;30:217-21.
15. Robles-Perez A, Luburich P, Rodriguez-Sanchon B, Dorca J, Nolla JM, Molina-Molina M, et al. Preclinical lung disease in early rheumatoid arthritis. Chron Respir Dis 2016;13:75-81.
16. Zayeni H, Haji-Abbasi A, Foumani SA, Tohidi M, Masooleh IS, Parsa BG, et al. Pulmonary involvement in rheumatoid arthritis: A cross-sectional study in Iran. Lung India 2016;33:49-52.
17. Rojas-Serrano J, Herrera-Bringas D, Perez-Roman DI, Perez-Dorame R, Mateos-Toledo H, Mejia M. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis. Clin Rheumatol 2017;36:1493-500.
18. Fragoulis GE, Nikiphorou E, Larsen J, Korsten P, Conway R. Methotrexate-Associated Pneumonitis and Rheumatoid Arthritis-Interstitial Lung Disease: Current Concepts for the Diagnosis and Treatment. Front Med (Lausanne) 2019;6:238.
19. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81.
20. Cavagna L, Monti S, Grosso V, Boffini N, Scorletti E, Crepaldi G, et al. The multifaceted aspects of interstitial lung disease in rheumatoid arthritis. BioMed Res Int 2013;2013:759760.
21. Ha YJ, Lee YJ, Kang EH. Lung Involvements in Rheumatic Diseases: Update on the Epidemiology, Pathogenesis, Clinical Features, and Treatment. Biomed Res Int 2018;2018:6930297.
22. Iqbal K, Kelly C. Treatment of rheumatoid arthritis-associated interstitial lung disease: a perspective review. Ther Adv Musculoskelet Dis 2015;7:247-67.
23. Yunt ZX, Chung JH, Hobbs S, Fernandez-Perez ER, Olson AL, Huie TJ, et al. High resolution computed tomography pattern of usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease: Relationship to survival. Respir Med 2017;126:100-4.
24. Solomon JJ, Chung JH, Cosgrove GP, Demoruelle MK, Fernandez-Perez ER, Fischer A, et al. Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J 2016;47:588-96.
25. Yunt ZX, Solomon JJ. Lung disease in rheumatoid arthritis. Rheum Dis Clin North Am 2015;41:225-36.
26. Ellman P, Ball RE .Rheumatoid disease" with joint and pulmonary manifestations. Br Med J 1948;2:816-20.
27. Cortet B, Flipo RM, Remy-Jardin M, Coquerelle P, Duquesnoy B, Remy J, et al. Use of high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 1995;54:815-9
28. Morrison SC, Mody GM, Benatar SR, Meyers OL. The lungs in rheumatoid arthritis--a clinical, radiographic and pulmonary function study. S Afr Med J 1996;86:829-33.
29. .Bhattacharya P, Ghosh S, Sengupta S, Dasgupta A, Ghosh K, Ghosh B. Clinicoradiological profile of interstitial lung disease in rheumatoid arthritis. Asian J Med Sci 2019;10:66-71.
30. Kalyani Praba P, Thamarai Selvi K, Vijay Anand B, Saravanan A. Evaluation of lung function tests in rheumatoid arthritis patients. Natl J Physiol Pharm Pharmacol 2017;7:693-6.
31. Hassan WU, Keaney NP, Holland CD, Kelly CA. Bronchial reactivity and airflow obstruction in rheumatoid arthritis. Ann Rheum Dis 1994;53:511-4.
32. Halimi L, Haghdoost AA, Alizadeh SM. Prevalence of cigarette smoking among Iranian women: a systematic review and meta-analysis. Med J Islam Repub Iran 2013;27:132-40.
33. Cereser L, Zuiani C, Graziani G, Girometti R, Como G, Zaja F, et al. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. Radiol Med 2010;115:205-14.
34. Gavelli G, Giampalma E. Sensitivity and specificity of chest X-ray screening for lung cancer: review article. Cancer 2000;89:2453-6.
35. Zrour SH, Touzi M, Bejia I, Golli M, Rouatbi N, Sakly N, et al. Correlations between high-resolution computed tomography of the chest and clinical function in patients with rheumatoid arthritis: prospective study in 75 patients. Joint Bone Spine 2005;72:41-7.
36. Lamblin C, Bergoin C, Saelens T, Wallaert B. Interstitial lung diseases in collagen vascular diseases. Eur Respir J Suppl 2001;32:69s-80.
37. Gabbay E, Tarala R, Will R, Carroll G, Adler B, Cameron D, et al. Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 1997;156:528-35.
38. Salliot C, van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 2009;68:1100-4.
39. Kinder AJ, Hassel AB, Brand J, Brownfield A, Grove M, Shadforth MF. The treatment of inflammatory arthritis with methotrexate in clinical practice: treatment duration and incidence of adverse drug reactions. Rheumatology (Oxford) 2005;44:61-6.
40. Conway R, Low C, Coughlan RJ, O'Donnell M, Carey JJ. Methotrexate and interstitial lung disease in rheumatoid arthritis-a systematic literature review and meta-analysis. Arthritis Rheumatol 2012;64(s918).
| Files | ||
| Issue | Vol 60, No 5 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i5.9557 | |
| Keywords | ||
| Arthritis Rheumatoid Lung diseases Pulmonary function tests | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mehrabi S, Ebrahimi B, Heidari F, Nazarinia MA. Pulmonary Function Test in Rheumatoid Arthritis Patients. Acta Med Iran. 2022;60(5):299-306.
